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Digestive Enzyme
Supplements: Splitting
Fact From Fiction


[Last updated 4th June, 2018]

Some lack the enzymes required to digest speci c


This can cause a range of digestive issues

including gas, bloating, and diarrhea.

Digestive enzyme supplements may remedy this,
but it depends on what food intolerance is the
problem. Sorry, Your Gluten
Sensitivity Is Actually
A Fructan Intolerance
This article is a sales-free look at the effectiveness How To Get Rid of
of digestive enzyme supplements, based on the Bloating: 9 Strategies
latest scienti c evidence.
Backed By Science

How To Use The

Contents [hide] Monash University
FODMAP Diet App: A
What are Digestive Enzymes? Step-By-Step Tutorial
How Do Digestive Enzymes Work?
Digestive Enzymes for IBS Treatment
Digestive Enzymes For Lactose Intolerance
Digestive Enzymes For Gluten Intolerance and
Celiac Disease
Who Should Take Digestive Enzymes?
Are Digestive Enzyme Supplements Safe?
What is the Best Digestive Enzyme?

What are Digestive Enzymes?

Digestive enzymes are chemicals produced in
our body.

All animals have them as

they are necessary to
break down food into
individual nutrients for
absorption. Hence the
name digestive enzymes.

Not all digestive enzymes are created equal. There

are speci c groups of enzymes needed for fats,
proteins and carbohydrates (1).

Carbohydrase – for digestion of

carbohydrates (and sugars)
Protease – for digestion of proteins
Lipase – for digestion of fats.

You should also be familiar with ‘Brush-Border’

enzymes that are produced in the small intestine,
such as lactase, maltase and sucrase.

If the body fails to produce enough digestive

enzymes, certain foods are not digested properly.
This leads to digestive stress that is often classi ed
as a food intolerance or Irritable Bowel Syndrome.

Unfortunately some are genetically predisposed

to low levels of a certain enzyme, which leads to
an intolerance. The most well-known is lactose
intolerance (more on that below).

Replacing enzymes with supplemental enzymes

has emerged as useful way to overcome certain

Summary: Digestive enzymes break down

food into individual nutrients. Some people
have low levels of certain enzymes, which
leads to food intolerance and digestive stress.
Supplementing digestive enzymes has
emerged as a useful alternative.

How Do Digestive Enzymes

I created an image to illustrate how digestive
enzymes work on a cellular level.

It shows the 3 main groups of enzymes, and how

they work, from left to right.

Once molecules are broken down into individual

parts, the body can use them.

Click to enlarge.

Digestive Enzymes for IBS

Those diagnosed with IBS
typically have trouble
digesting foods high in
FODMAP carbohydrates.

Digestive enzyme
supplements containing
alpha-galactosidase (a
type of carbohydrase
enzyme) may help with
the starchy carbs, at least
in theory.

Alpha-galactosidase helps break down larger

complex carbohydrates (oligosaccharides) into
smaller easier to digest particles
(monosaccharides). However both of these are still
FODMAPs, and the scienti c evidence for its use
in IBS is minimal.

The Research
One study of 19 participants found that alpha-
galactosidase reduced gas after eating a high
bre (high FODMAP) meal. But there was only a
small number of participants and it was not
speci c to IBS patients (3).

A more recent study of 101 IBS patients found

those supplementing with alpha-galactosidase
experienced a greater reduction in IBS symptoms
compared to placebo (fake pill), but the difference
was not statistically signi cant. That means the
bene t observed might be due to factors other
than the enzyme supplement (4).

Another study of 90 IBS patients looked at the

effects of a supplement called Biointol, which is a
combination of some soluble bers (beta-glucan
and inositol) and digestive enzymes. I could not
nd the exact blend of enzymes used, but most
supplements are typically a combination of
carbohydrases, lipases and proteases (5).

Biointol use was shown to help improve

abdominal pain, bloating and atulence
compared to placebo. However, because it was a
blend of ingredients it’s not possible to say how
effective the digestive enzymes were.

The effect of Biointol on bloating in control

(placebo) group vs Biointol group. A decrease was
observed in the IBS patients over the 4 weeks.

A review paper of 5 individual studies supports the

use of alpha-galactosidase to reduce digestive
discomfort after eating. However, the authors
were af liated with an enzyme supplement
manufacturer, and the studies looked at a small
number of participants (2).

Lastly, a recent study has just been released

looking at the effectiveness of alpha-
galactosidase on IBS symptoms. This study was
speci cally measuring the effect of alpha-
galactosidase when taken with foods high in
galacto-oligosaccharides (GOS) a speci c
FODMAP carbohydrate.

Thirty-one participants with IBS were recruited

and they went through 3 stages, placebo, half
dose of enzyme and full dose of enzyme. At each
stage they consumed a diet high in GOS but low
in other FODMAPs.

The full dose enzyme but not the half dose saw a
reduction in IBS symptoms compared to the
placebo. However, no change in breath hydrogen
production was seen with treatment (breath
hydrogen is used to measure sensitivity to a
particular FODMAP). The signi cance of this is not
yet fully understood.
Median overall symptom score for each day of the
study periods.

Because this study was speci c to high GOS foods

the effectives in people who are not sensitive to
GOS is still unknown. The researchers recommend
the use of alpha-galactosidase enzymes for IBS
patients who have speci cally identi ed a GOS
sensitivity and not as a blanket recommendation
for all IBS patients (14).

Summary: Digestive enzymes containing

alpha-galactosidase may help alleviate gas
and other IBS symptoms in some people.
However, there’s still a lack of consistent
scienti c evidence and it is more likely
effective in those with a galacto-
oligosaccharide sensitivity.

Digestive Enzymes For Lactose

One of the most recognised and common food
intolerance is lactose intolerance (not to be
confused with milk allergy).

Lactose intolerance is caused by low levels of the

Lactase enzyme that is required to break down
lactose (dairy sugar).

Lactase is a type of beta-

galactosidase, as opposed
to alpha-galactosidases
that digest starchy carbs.
Lactase is also part of the
the group of enzymes
called carbohydrases.

Lactose that remains

partially or completely
undigested in the intestine causes gas, bloating
and diarrhea (1).

Forunately, lactase enzyme supplements are

readily available and there is much stronger
evidence for their use compared to alpha-
galactosidases enzymes.

They are most useful when taken before eating

small amounts of dairy, but not as effective for
large amounts (6).

Finding the ideal dose takes some

experimentation as it varies between individuals.
For some it can be largely ineffective, depending
on the individual’s level of intolerance (7, 8).

Lactase supplements all contain varying amounts

of beta-galactosidase and are expressed as FFC
lactase units. You can determine the strength of
the supplements by looking for these units on the

Summary: Lactase supplements may help

people with lactose intolerance consume
small amounts of dairy without side effects.
Digestive Enzymes For Gluten
Intolerance and Celiac Disease
Gluten intolerance (also
called non-celiac gluten
sensitivity) and
celiac disease are two very
different conditions.

But they are both

characterised by an
inability to digest a protein
called gluten.

A number of digestive enzymes on the market

(containing protease enzymes) claim to
breakdown the protein gluten, which may seem
like an attractive option. Unfortunately, there is a
lack of evidence to support their effectiveness.

One study analysed ve commercially available

supplements and found they did not fully
breakdown the problematic gluten molecules
(gliadin) (9, 10).

In saying that, there have been recent advances

for a new supplement (GluteGuard) designed for
gluten intolerance and celiac disease patients.

The active ingredient in GluteGard is the extract

from papaya fruit called caricain. In vitro
(laboratory) studies have shown that caricain can
breakdown gliadin molecules (11).

However, research in humans is lacking . One

recent human study concluded caricain may help
with gluten digestion, but it only had a small
number of participants… a large percentage of
whom left the study before its conclusion (12).
The results will need to be replicated at least once
in a larger study before health professionals can
con dently recommend caricain for gluten
intolerance and celiac disease.     

Summary: Most available enzyme

supplements are ineffective for treating
gluten intolerance or celiac disease. In the
future, there may be more evidence to
support the use of a pill containing caricain to
safeguard against inadvertent gluten

Who Should Take Digestive

As you can see the effectiveness of digestive
enzymes is in its infancy.

At least, from a science-based point of view.

The only strong use for over-the-counter (OTC)

enzymes at this point is those with isolated
lactose intolerance or IBS. And that depends on
the individual’s particular FODMAP intolerance.

There is also Pancreatic Enzyme Replacement

Therapy (PERT), which refers to prescription
pancreatic enzymes necessary to help treat
exocrine pancreatic insuf ciency (EPI) (11).

Early evidence suggests PERT may be bene cial

for people with the following conditions too, but
some are in very early stage research (12, 13):

Cystic brosis
Pancreatic cancer
Pancreatic surgery
Gastric surgery
Insulin-dependent diabetes
Lysosomal storage disease
Ulcerative colitis
Crohn’s disease (but likely not).

I note on other websites – that sell digestive

enzymes – they are recommended for a range of
other conditions such as Hypochlorhydria and
age-related enzyme insuf ciency. But I could not
nd any evidence of this.

Are Digestive Enzyme

Supplements Safe?
Digestive enzyme
supplements are currently
available over-the-counter
(except those required for
medical conditions) and
are considered safe for
those who are otherwise
healthy (1,2).

However, alpha-galactosidase supplements may

reduce the effectiveness of some diabetic
medications and could be unsafe for those with
diabetes (2).

And PERT must be done under medical


Enzyme Sources
Digestive enzymes that contain pancreatic
enzymes are usually made from porcine (pig) or
other animal sources. These are usually listed in
the ingredients as Pancreatin.

Animal sources are the most well-studied and

effective, at least as pancreatic enzyme

In fact, all FDA approved PERT medications are

made from animal sources. Currently there is no
alternative for those who do not eat pig or other
animal products.

However, for alpha-galactosidase and lactase

enzymes this is not an issue.

Alpha-galactosidase supplements are made from

fungi sources and Lactase supplements from
yeast and mould sources.

Summary: Digestive enzymes are considered

safe for those who are otherwise healthy. But
they are not appropriate for many medical
conditions and certain personal food choices. 

What is the Best Digestive

Overall it seems that certain digestive enzymes
can improve gastrointestinal issues.

Particularly for cases of IBS, but it depends on the

individual. There is early evidence they can assist
with a number of other medical conditions as

However, if you do not have a diagnosed enzyme

de ciency or medical condition that may bene t
from supplementation, it’s unlikely additional
digestive enzyme will be bene cial.

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